Francesca Romana Grippaudo

Comparative Evaluation of Traditional, Ultrasonic, and Pneumatic Assisted Lipoplasty: Analysis of Local and Systemic Effects, Efficacy, and Costs of These Methods

Abstract. Recently ultrasound assisted liposuction (UAL) and pneumatic assisted liposuction (PAL) have been introduced as an attempt to improve the results and reduce the pitfalls of standard liposuction (SAL). Until now no studies comparing, at the same time, UAL, PAL, and SAL have been published. The aim of this study was to analyze these methods from the surgeons point of view, focusing not only on aesthetic results but also on local and systemic trauma, efficacy, handling, and cost. Forty-five cosmetic patients affected by local lipodystrophy, divided into three equal groups, have undergone liposuction with the three above-mentioned techniques. Quantitative and qualitative analysis of lipoaspirates, together with blood chemistry, local and systemic complications, time to aspirate 100 cm3, distress, fatigue, and costs of the procedures, has been recorded. Our results showed bloodier lipoaspirates in SAL and a higher percentage of triglycerides in UAL lipoaspirates. Blood tests revealed a slight decrease in the postoperative Hb in SAL only. Early complications observed were four erythemas in PAL, three ecchymoses in SAL, and one long-lasting edema in UAL. Aesthetic results rated by independent viewers were similar for all methods. Efficacy was higher in the PAL group (4 min × 100 cm3 fat aspirated) than in SAL (7 min × 100 cm3 fat) and UAL (10 min × 100 cm3 fat). Surgeons distress was higher in PAL than in SAL and UAL. Surgeons fatigue was much lower in the PAL group than in the others. Costs expressed as multiples of 1 unit (1 unit =

High-frequency sonography of temporary and permanent dermal fillers

500 U.S.) were highest for UAL, low for PAL, and lowest for SAL. In conclusion, PAL and UAL caused reduced vascular injury, UAL being more selective for adipocyte removal. Complications of UAL and PAL were mostly related to the longer learning curve of these methods. The UAL procedure was much more expensive than PAL and, especially, SAL. PAL proved to be a handy technique, with the most favorable cost/benefit ratio, and seems to be the best option for busy liposuction practices or fast office procedures, even though the choice of the ideal technique always depends on the surgeons preference.

The utility of high-frequency ultrasound in dermal filler evaluation.

Background: Dermal fillers are used widely; some have a permanent effect, whereas others are temporary. The aim of this study is to describe the ultrasonographic features of permanent and temporary fillers injected into patients for cosmetic purposes.

Management of Craniofacial Development in the Parry-Romberg Syndrome: Report of Two Patients

Aim of this study is to describe the use of high-frequency ultrasound to ascertain the site, quantity, and type of filler injected in the soft tissue of the face, with respect to reliability of the procedure and the analysis costs. Between December 2006 and August 2010, 80 subjects aged 25 to 65 years, who underwent facial filler augmentation, were submitted to high-frequency sonography. Of total, 42 patients (22 after temporary filler and 20 after permanent filler) were healthy and satisfied of the treatment, and 38 patients sought consultation for filler-related problems. The nature of the injected filler was known in 86.25% of the patients, whereas it was unknown in 13.75% of the patients. Besides 4 patients, previously treated with temporary products, in which no foreign material was detected, high-frequency sonography was able to identify and quantify the presence of filler in the soft tissue of 97% of patients. Moreover, it was possible to detect inflammatory reaction (that were often silent), granulomas, and recognize the presence of diverse fillers in the same area. Ultrasonography has proved to be a useful, inexpensive, noninvasive tool for the identification of the site, quantity, and often even nature of the filler injected.

Effects of traditional and ultrasonic liposuction on adipose tissue: a biochemical approach.

Objective The aim of this article is to describe the orthodontic therapy for Parry-Romberg syndrome. The therapeutic goal is to minimize the wasting effects of progressive atrophy on facial development of a part of the face. Design To correct problems affecting craniofacial development of these patients, occurring during puberty, an orthodontic appliance was employed, which helps maintain parallelism of the facial planes, in particular the mandibular plane. Setting Orthodontic care was carried out in the Dental Clinic of the Catholic University of the Sacred Heart of Rome. Intervention Two patients underwent orthodontic therapy for 6 years. Appliances were checked every month and modified periodically so as to adapt to facial bone growth. Results At the end of craniofacial growth, the mandible was almost symmetric and the problem relating to atrophy remained confined to the initial area. Cephalometric analyses demonstrated that the occlusal plane and the mandibular plane maintained a straight orientation in relation to the bizygomatic plane. The ratio between the left and right side of the ramus and condyle, in the mandible, improved. Conclusions The use of orthodontic therapy allows patients affected by hemifacial progressive atrophy to present a more harmonic face at the end of puberty when final reconstruction can be planned. These results provide for a limitation of surgical intervention to the sclerodermic area alone.

Ultrasound-assisted liposuction for the removal of siliconomas

Little is known about the interaction of ultrasonic liposculpture with fat tissue. The surgical technique is well established and its clinical effects are satisfactory. However, the in vivo effects on adipose tissue remain to be determined. Previous studies have shown that ultrasound waves break fat cells. The purpose of this study was to ascertain whether ultrasound waves can cause the release of fatty acids from the molecular structure of triglycerides. A double-blind study was designed with samples obtained from traditional and ultrasonic liposuction of an equivalent area in the same patient. Samples were checked for triglycerides and for free fatty acids. Triglyceride values were always higher in the sample that had undergone ultrasonic procedure. No significant differences were observed between the free fatty acid chromatograms of the two kinds of samples analyzed. Data showed that no changes occurred in the triglyceride molecule when using ultrasound waves in the experimental conditions.

Diagnosis and management of dermal filler complications in the perioral region

In the past, the traditional methods of removing siliconomas have been excision of the affected tissues or suction of the injected silicone. Unfortunately siliconomas are often found in exposed areas, where it is undesirable to leave visible scars, and suction is technically difficult and often unsuccessful because the affected tissues are so hard. Because we have used ultrasound‐assisted liposuction for other procedures since 1984, it seemed logical to find out whether this technique would be useful to remove siliconomas. We have used it in three such patients, ranging in age from 36 to 84 years. Our mean follow up is 38 months (range 18 months–4 years). We have found that it results in improvement in all patients. The only problem was a minor burn at the entrance port in one patient.

Role of pre-emptive analgesia in reduction mammaplasty

Abstract Background: Lip augmentation with injectable materials is a popular aesthetic procedure. When complications occur, patients often ignore which material was implanted, thus making subsequent treatments difficult. This study aims to present the diagnosis and management of dermal filler complications in the perioral region. Study design: The Medical charts of 26 patients with filler complications in the oral region were reviewed. All patients were submitted to High Frequency Ultrasound, often complemented by Magnetic Resonance Imaging (MRI) and White Blood Cell Scintigraphy, to evaluate filler characteristics and complication types. Antibiotic, corticosteroid or surgical treatment was therefore planned. Results: Imaging always identified dermal fillers in the oral region, distinguishing among infections, fibrosis, granulomatous inflammation and product migration. Nine patients received surgery, ten received medical treatments, six received both, and one refused treatment. Eighty percent of the patients presented an improvement after three- year follow-up. Conclusions: Complications of oral region fillers are similar in clinical presentation but differ in etiology, therefore necessitating different clinical approaches. Imaging techniques add useful information for treatment planning.

Potential regulatory molecules in the human trabecular meshwork of patients with glaucoma: Immunohistochemical profile of a number of inflammatory cytokines

Pre-emptive analgesia is an antinociceptive treatment that prevents altered central excitability from high intensity noxious stimuli. The aim of this study was to evaluate the efficacy of pre-emptive analgesia in patients due to have elective breast reduction that usually requires drugs for postoperative pain control. Sixty women, ASA grades I-II, were randomly divided into two groups: 30 patients were given ropivacaine infiltration 1.5 mg/ml plus adrenaline 1/200000 in normal saline 100 ml before the skin incision, and 30 had normal saline 100 ml plus adrenaline 1/200000 infiltrated. Postoperative pain was evaluated by an observer who was unaware of the treatment given, and scored on a visual analogue score (VAS) during the first 72 hours postoperatively. Analgesic requirements were recorded. There was a statistically significant difference between groups in the amount of additional pain control required during the early postoperative period, which suggests that pre-emptive analgesia reduces pain after reduction mammaplasty.Pre-emptive analgesia is an antinociceptive treatment that prevents altered central excitability from high intensity noxious stimuli. The aim of this study was to evaluate the efficacy of pre-emptive analgesia in patients due to have elective breast reduction that usually requires drugs for postoperative pain control. Sixty women, ASA grades I-II, were randomly divided into two groups: 30 patients were given ropivacaine infiltration 1.5 mg/ml plus adrenaline 1/200,000 in normal saline 100 ml before the skin incision, and 30 had normal saline 100 ml plus adrenaline 1/200,000 infiltrated. Postoperative pain was evaluated by an observer who was unaware of the treatment given, and scored on a visual analogue score (VAS) during the first 72 hours postoperatively. Analgesic requirements were recorded. There was a statistically significant difference between groups in the amount of additional pain control required during the early postoperative period, which suggests that pre-emptive analgesia reduces pain after reduction mammaplasty.

Intense pulsed light photoepilation in hirsute women: the role of obesity

Glaucoma occurs when there are imbalances between the production and the drainage of the eye liquid. The vast majority of the aqueous humor leaves the eye through the trabecular meshwork (TM). The cause of hypertonicity may be due to an alteration in the thickness of the TM. In the majority of cases the molecular changes that determine primary open‑angle glaucoma (POAG) are unclear. However, it has been hypothesized that the significant increase in the extracellular matrix (ECM) of the fibrillary bands in the TM is associated with possible inflammatory conditions. In this study the tissue distribution of interleukin (IL)‑6, IL‑1β, transforming growth factor-β1 (TGF‑β1), vascular endothelial growth factor (VEGF) and tumor necrosis factor α (TNF‑α) was analyzed in TM samples from patients with POAG by immunohistochemistry. Seven specimens from patients with POAG and three control tissues were analyzed by immunohistochemistry using specific antibodies against these cytokines. Morphological changes in the TM, such as increased cell content, macrophages, fibrosis and accumulation of neutrophils, were observed by transmission electron microscopy. In human TM tissues, an evident immunoreactivity for IL‑6, IL‑1β and TNF‑α was observed in patients with POAG when compared with the control subjects, indicating that these cytokines may be correlated with disease activity. TM endothelial cells secrete a number of factors and cytokines that modulate the functions of the cells and the ECM of the conventional outflow pathway. In the TM in glaucoma, macrophages produce cytokines, including IL‑6, IL‑1β and TNF‑α, leading to an acute inflammatory response and recruitment of other immune cells, including T lymphocytes. In addition, TGF‑β1 regulates and induces the expression of IL‑6 in TM that indirectly induces angiogenesis by stimulating VEGF expression. The present results support previous evidence that suggests that growth factors and cytokines can induce ECM remodelling and alter cytoskeletal interactions in the TM.